How do structured education programmes work? An ethnographic investigation of the dose adjustment for normal eating (DAFNE) programme for type 1 diabetes patients in the UK
How do structured education programmes work? An ethnographic investigation of the dose adjustment for normal eating (DAFNE) programme for type 1 diabetes patients in the UK
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DOI：
10.1016/j.socscimed.2010.04.030
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发表时间：
2010-08-01
影响因子：
5.4
通讯作者：
Rankin, David
中科院分区：
文献类型：
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作者：
Lawton, Julia;Rankin, David
针对糖尿病和其他慢性病患者的结构化教育计划（SEP）正在英国和其他地方广泛采用。试验表明，它们比说教方法更有效，患者的学习、血糖控制和生活质量都有所改善。然而，这些改进的原因尚不清楚。为了确定 SEP 的作用方式和原因，我们对正常饮食剂量调整 (DAFNE) 计划进行了定性调查。 DAFNE 是针对英国 1 型糖尿病患者的成熟 SEP，指导他们改变胰岛素剂量，以改善饮食自由和血糖控制。观察了 6 个为期 5 天的课程，并对 30 名年龄在 18-59 岁的患者完成课程后进行了深入访谈。在接受治疗之前，许多患者已经形成了保护行为和风险规避策略，例如提高血糖水平以避免低血糖，或降低血糖水平以避免出现并发症。实施课程中建议的胰岛素剂量调整通常需要患者走出舒适区并接受他们认为的风险，至少在最初是这样。为了理解和解释课程动态和结果，我们借鉴了亚当斯的风险恒温器概念——该概念假设所有个人都配备了一个内部工具，用于衡量和应对风险——并为其添加了物质层面。在此过程中，我们强调了（体现的）群体互动和体验的动态方式，以及它们与课程交付其他方面（例如教育者监督和课程规则的运用）的结合，有助于加强学习并促进患者转变为胰岛素剂量调整受试者。这包括患者根据其他人的胰岛素剂量调整经验重新校准风险恒温器的体内过程。 (C) 2010 Elsevier Ltd. 保留所有权利。
Structured education programmes (SEPs) for patients with diabetes and other chronic diseases are being widely adopted across the UK and elsewhere. Trials suggest they are more efficacious than didactic approaches, with patients showing improvements in learning, blood glucose control and quality of life. However, the reasons for these improvements are not well understood. To establish how, and why, SEPs work, we undertook a qualitative investigation of the Dose Adjustment for Normal Eating (DAFNE) programme. DAFNE is a well-established SEP for type 1 diabetes patients in the UK, which teaches them to alter their insulin doses in order to improve dietary freedom and blood glucose control. Six five-day courses were observed and in-depth interviews conducted with 30 patients aged 18-59 years on completion of the courses. Prior to their courses, many patients had developed protective behaviours and risk-avoiding strategies, such as running blood glucose levels high to avoid hypoglycaemia, or low to avoid developing complications. Implementing the insulin dose adjustments recommended on the course often required patients to move out of comfort zones and take what they had perceived, initially at least, as risks. In order to understand and explain course dynamics and outcomes, we draw upon Adams' concept of the risk-thermostat - which presupposes that all individuals are equipped with an internal instrument by which they gauge and respond to risk - and add a corporeal dimension to it. In doing so, we highlight the dynamic ways in which (embodied) group interactions and experiences, and their enmeshment with other aspects of course delivery, such as educator surveillance and employment of course rules, helped to enhance learning and promote patients' transformations into insulin dose adjusting subjects. This included inter-corporeal processes through which patients recalibrated their risk thermostats in light of the insulin dose adjustment experiences of others. (C) 2010 Elsevier Ltd. All rights reserved.